The American surgeon
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The American surgeon · Jul 2004
Review Case ReportsPinch-off syndrome: case report and collective review of the literature.
Pinch-off syndrome (POS) occurs when a long-term central venous catheter is compressed between the clavicle and the first rib. The compression can cause transient obstruction of the catheter and may result in a tear or even complete transsection and embolization of the catheter. POS may be preceded by a finding of "pinch-off sign" on chest X-ray (CXR) films in which the catheter is indented as it passes beneath the clavicle. ⋯ Treatment of POS is removal of the catheter. If the tip of the catheter has embolized, it can usually be retrieved percutaneously with a transvenous snare. POS can be prevented by using the internal jugular vein for access rather than the subclavian vein.
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The American surgeon · Jul 2004
Case ReportsPrimary duodenal low-grade mucosa-associated lymphoid tissue lymphoma presenting with outlet obstruction.
Low-grade lymphoma arising in mucosa-associated lymphoid tissue (MALT) of the duodenum represents a very rare neoplasm. We report an unusual presentation of primary duodenal MALT lymphoma in a 78-year-old man. The patient initially presented with a suspected pulmonary embolus and was anticoagulated, which precipitated a major gastrointestinal hemorrhage. ⋯ Celiac, peripancreatic, pelvic, and cervical nodes were also involved with tumor. Bone marrow was also positive for metastasis. The patient was postoperatively treated with chemotherapy for stage IV disease.
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Severity of injuries from air-powered weapons can be underappreciated. Transformation of these weapons into toys makes them available to children. Our experience reveals the underestimated injury severity and emphasizes need for prompt trauma evaluation. ⋯ In the pediatric population, air-gun injuries can be underestimated. Lack of collateral tissue damage makes wounds appear innocuous to unsuspecting medical personnel resulting in delayed care. During initial evaluation, injuries from air guns deserve the same respect as those caused by conventional firearms.
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The American surgeon · May 2004
ReviewSkin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations.
The last several decades have witnessed significant advances in the surgical management of breast cancer. Although many have embraced breast conservation as the procedure of choice, some patients will still opt for mastectomy for a variety of reasons. ⋯ However, this surgical approach must be considered within a multidisciplinary context, and there are a number of perioperative issues that need to be considered. In addition, newer techniques, which spare the nipple and/or areola, warrant further examination.
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The American surgeon · May 2004
Comparative StudyCongenital diaphragmatic hernia repair on extracorporeal life support: a decade of lessons learned.
Congenital diaphragmatic hernia (CDH) is a vexing anomaly that manifests with variable pulmonary compromise in neonates. More than one-third of neonates with CDH require extracorporeal membrane oxygenation (ECMO) for refractory pulmonary hypertension (PHN). To assess the outcome of neonates having CDH repair on ECMO, we reviewed our experience for babies treated between 1992 and 2003. ⋯ Comparisons between survivors and nonsurvivors showed a significantly increased mortality for infants placed on VA bypass (P < 0.01). However, no other variable was predictive of survival. We conclude that CDH repair on ECMO is technically feasible, shows similar survival to the Extracorporeal Life Support Organization (ELSO) registry, and is associated with few bleeding complications.